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中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 27 -31. doi: 10.3877/cma.j.issn.2095-6568.2022.01.007

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脉冲电场消融治疗心房颤动
唐闽1,()   
  1. 1. 100037 北京,中国医学科学院 北京协和医学院 国家心血管病中心 心血管疾病国家重点实验室 阜外医院心律失常中心
  • 收稿日期:2022-02-09 出版日期:2022-03-25
  • 通信作者: 唐闽
  • 基金资助:
    国家自然科学基金资助项目(U1913210)

Pulsed field ablation for treatment of atrial fibrillation

Min Tang1,()   

  1. 1. Center of Arrhythmia, Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
  • Received:2022-02-09 Published:2022-03-25
  • Corresponding author: Min Tang
引用本文:

唐闽. 脉冲电场消融治疗心房颤动[J/OL]. 中华心脏与心律电子杂志, 2022, 10(01): 27-31.

Min Tang. Pulsed field ablation for treatment of atrial fibrillation[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(01): 27-31.

脉冲电场消融(pulsed field ablation,PFA)是直流电消融的“变种”。PFA可实现间歇性、短时程和不同强度的脉冲场释放,从而造成特定细胞的可逆和不可逆“电穿孔”损伤。基于优越的组织细胞特异性,PFA在过去的数十年间分别在基因转染、制药工程、食品加工和实体肿瘤的临床治疗中大放异彩。本文立足于PFA的发展历史、损伤机制、不良反应、动物试验和人体试验,以系统地介绍PFA治疗心房颤动的原理和应用现状。

图1 脉冲电场隔离肺静脉示例[1A:左下肺静脉口部消融前(左)可见34、45和56电极标测到肺静脉电位(箭头);消融后(右)相应肺静脉电位消失;1B:右前斜体位透视见导管以花瓣状展开消融左下肺静脉口部;1C:心腔内超声见导管以梭状展开紧密贴靠于左下肺静脉口部]
[1]
Izza Z, Miller J, Zipes D. Clinical arrhythmology and electrophysiology: a companion to Braunwald's heart diseases[M]. 2nd ed.Philadelphia: Elsevier, 2019.
[2]
DeSimone CV, Kapa S, Asirvatham SJ. Electroporation: past and future of catheter ablation[J]. Circ Arrhythm Electrophysiol, 2014, 7(4):573-575.
[3]
Neumann E, Schaefer-Ridder M, Wang Y, et al. Gene transfer into mouse lyoma cells by electroporation in high electric fields[J]. EMBO J, 1982, 1(7):841-845.
[4]
Wijffels MC, Timmermans CC, van Suylen RJ, et al. Internal atrial shock delivery by standard diagnostic electrophysiology catheters in goats: effects on atrial electrogram amplitude and tissue architecture[J]. Europace, 2007, 9(4):203-207.
[5]
Wittkampf FH, van Driel VJ, van Wessel H, et al. Feasibility of electroporation for the creation of pulmonary vein ostial lesions[J]. J Cardiovasc Electrophysiol, 2011, 22(3):302-309.
[6]
Maor E, Sugrue A, Witt C, et al. Pulsed electric fields for cardiac ablation and beyond: a state-of-the-art review[J]. Heart Rhythm, 2019, 16(7):1112-1120.
[7]
Reddy VY, Koruth J, Jais P, et al. Ablation of atrial fibrillation with pulsed electric fields: an ultra-Rapid, tissue-selective modality for cardiac ablation[J]. JACC Clin Electrophysiol, 2018, 4(8):987-995.
[8]
Hunter DW, Kostecki G, Fish JM, et al. In vitro cell selectivity of reversible and irreversible: electroporation in cardiac tissue[J]. Circ Arrhythm Electrophysiol, 2021, 14(4):e008817.
[9]
Koruth JS, Kuroki K, Kawamura I, et al. Focal pulsed field ablation for pulmonary vein isolation and linear atrial lesions: a preclinical assessment of safety and durability[J]. Circ Arrhythm Electrophysiol, 2020, 13(6):e008716.
[10]
Neven K, van Driel V, van Wessel H, et al. Safety and feasibility of closed chest epicardial catheter ablation using electroporation[J]. Circ Arrhythm Electrophysiol, 2014, 7(5):913-919.
[11]
Koruth J, Kuroki K, Iwasawa J, et al. Preclinical evaluation of pulsed field ablation: electrophysiological and histological assessment of thoracic vein isolation[J]. Circ Arrhythm Electrophysiol, 2019, 12(12):e007781.
[12]
Bardy GH, Coltorti F, Ivey TD, et al. Some factors affecting bubble formation with catheter-mediated defibrillator pulses[J]. Circulation, 1986, 73(3):525-538.
[13]
van Es R, Groen M, Stehouwer M, et al. In vitro analysis of the origin and characteristics of gaseous microemboli during catheter electroporation ablation[J]. J Cardiovasc Electrophysiol, 2019, 30(10):2071-2079.
[14]
Chung EM, Banahan C, Patel N, et al. Size distribution of air bubbles entering the brain during cardiac surgery[J]. PLoS One, 2015, 10(4):e0122166.
[15]
Neven K, Füting A, Byrd I, et al. Absence of (sub-)acute cerebral events or lesions after electroporation ablation in the left-sided canine heart[J]. Heart Rhythm, 2021, 18(6):1004-1011.
[16]
Reddy VY, Dukkipati SR, Neuzil P, et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II[J]. JACC Clin Electrophysiol, 2021, 7(5):614-627.
[17]
Abstracts from the 26th Annual international atrial fibrillation symposium[J]. J Cardiovasc Electrophysiol, 2021, 32(5):1467-1515.
[18]
Reddy VY, Anter E, Rackauskas G, et al. Lattice-tip focal ablation catheter that toggles between radiofrequency and pulsed field energy to treat atrial fibrillation: a first-in-human trial[J]. Circ Arrhythm Electrophysiol, 2020, 13(6):e008718.
[19]
van Driel VJ, Neven KG, van Wessel H, et al. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency[J]. Circ Arrhythm Electrophysiol, 2014, 7(4):734-738.
[20]
Witt CM, Sugrue A, Padmanabhan D, et al. Intrapulmonary vein ablation without stenosis: a Novel balloon-based direct current electroporation approach[J]. J Am Heart Assoc, 2018, 7(14):e009575.
[21]
Koruth JS, Kuroki K, Kawamura I, et al. Pulsed field ablation versus radiofrequency ablation: esophageal injury in a novel porcine model[J]. Circ Arrhythm Electrophysiol, 2020, 13(3):e008303.
[22]
Koruth JS, Kuroki K, Iwasawa J, et al. Feasibility, safety, and durability of porcine atrial ablation using a lattice-tip temperature-controlled radiofrequency ablation catheter[J]. J Cardiovasc Electrophysiol, 2020, 31(6):1323-1331.
[23]
Yavin H, Brem E, Zilberman I, et al. Circular multielectrode pulsed field ablation catheter Lasso pulsed field ablation: Lesion characteristics, durability, and effect on neighboring structures[J]. Circ Arrhythm Electrophysiol, 2021, 14(2):e009229.
[24]
Howard B, Haines DE, Verma A, et al. Reduction in pulmonary vein stenosis and collateral damage with pulsed field ablation compared with radiofrequency ablation in a canine model[J]. Circ Arrhythm Electrophysiol, 2020, 13(9):e008337.
[25]
Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation[J]. J Am Coll Cardiol, 2019, 74(3):315-326.
[26]
Loh P, van Es R, Groen M, et al. Pulmonary vein isolation with single pulse Irreversible electroporation: a first in human study in 10 patients with atrial fibrillation[J]. Circ Arrhythm Electrophysiol, 2020, 13(10):e008192.
[27]
De Potter T, Reddy V, Neuzil P, et al. Acute safety and performance outcomes from the inspIRE trial using a novel pulsed field ablation system for the treatment of paroxysmal atrial fibrillation[J]. Eur Heart J, 2021, 42:ehab724-0380.
[28]
Verma A, Boersma L, Haines DE, et al. First-in-human experience and acute procedural outcomes using a novel pulsed field ablation system: The PULSED AF Pilot Trial[J]. Circ Arrhythm Electrophysiol, 2022, 15(1):e010168.
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